KISEP J Korean Neurosurg Soc 37 : 232-234, 2005

Meningeal Solitary Fibrous Tumor

Case Report

Jong-Myong Lee, M.D.

Department of Neurosurgery, Chonnam National University, Medical School, Gwangju, Korea

We report a rare case of a patient with meningeal solitary fibrous tumor. A 60-year-old woman presented with right leg
monoparesis. Brain magnetic resonance imaging demonstrates a well enhancing huge mass, located in left parietal lobe.
Cerebral angiography demonstrating increased vascularity in area of the tumor, which had feeder vessels extending from
the internal carotid artery and external carotid artery. A presumptive diagnosis of meningioma or hemangiopericytoma
was considered. At surgery, the consistency was firm and had destroyed the dura and skull. A gross total resection was
performed. Immunohistochemically, tumor was strongly, and widely, positive for CD34 and vimentin. There was no
staining for epithelial membrane antigen(EMA), S-100 protein, cytokeratin, and glial fibrillary acidic protein (GFAP).
Differential diagnosis of intracranial solitary fibrous tumor includes fibroblastic meningioma, meningeal
hemangiopericytoma, neurofibroma, and schwannoma.

KEY WORDS : Solitary fibrous tumor·CD34·Meningeal tumor.

Introduction

I ntracerebral solitary fibrous tumors(SFTs) are rare, benign

mesenchymal neoplasm2). In 1931, Klemperer and Rabin
first described solitary fibrous tumor, a rare tumor that occurs
most often in the visceral pleura5). SFT can mimic other
benign or malignant spindle cell tumors. We present a case of
meningeal SFT. The meningeal involvement of solitary
fibrous tumor is rare and there has been less than 100 cases
reported previously in literature. The clinical, radiological, and
pathological features of this tumor, including light microscopic
and immunohistochemical features, are delineated and
differential diagnosis is discussed.

Case Report

A 60-year woman presented with a 4-year history of right

leg weakness. The neurological examination at admission
revealed mild weakness on right lower extremity. Brain
magnetic resonance imaging(MRI) demonstrated a huge well
Fig. 1. Magnetic resonance imaging demonstrates a huge mass,
which is marked enhanced in the left parietal lobe and involved the
superior sagittal sinus.

enhancing mass, located in left parietal lobe and attached the external carotid artery, and superior sagittal sinus was occluded
superior sagittal sinus (Fig. 1). Cerebral angiography demo- by the tumor.
nstrating increased vascularity in area of the tumor, which had
feeder vessels extending from the internal carotid artery and Operation and Pathologic Finding
Received：August 11, 2004 Accepted：October 26, 2004
Address for reprints：Jong-Myong Lee, M.D., Department of
Neurosurgery, Chonnam National University, Medical School, 8
Hak-dong, Dong-gu, Gwangju 501-757, Korea
G ross total excision of the lesion was achieved by pa-
ramedian parietal craniotomy with neuronavigation
guidence. The tumor was grayish in color, firm in consistency
Tel : 062) 220-6606, 6600 Fax : 062) 224-9865
E-mail : pinkfloyd74@hanmail.net
and attached to the dura, and had destroyed the dura mater.
The tumor invaded the superior sagittal sinus, and superior

232 J Korean Neurosurg Soc 37


Fig. 2. Cerebral angiography demonstrating increased vascularity in
area of the tumor, which had feeder vessels extending from the
internal carotid artery and external carotid artery, and superior
sagittal sinus was occluded by the tumor.
sagittal sinus was occluded by the tumor. The tumor was extr-
aaxial mass and attached to meninges with bony hyperostosis.
The tumor was debulked initially and dissected along the
tumor plane. The superior sagittal sinus was ligated and gross
total removal was achieved including a nubbin of tumor that
had penetrated the superior sagittal sinus.
Tissues were fixed in 10% formaldehyde, embedded in
paraffin, and stained hematoxylin stains. S-100 protein, glial
fibrillary acidic protein(GFAP), cytokeratin, viemntin, CD34,
epithelial membrane antigen(EMA), actin, p53, desmin, and
A B
C D
Fig. 3. The tumor shows highly cellular spindle cell tumors A : a
collagen-rich background, and exhibiting regional variation B :
Tumor cells have enlongated nuclei with a delicate chromatin
pattern, and scant eosinophilic cytoplasm. Few mitotic figures are
also noted D : But there is no intranuclear inclusions, cellular whorls, or
psammoma bodies (A. H & E, ×40, B. ×40, C. ×100, D. ×200).
JM Lee
A B
Fig. 4. Immunohistochemically, The tumor is strongly, and widely,
positive for CD34. There is no staining for glial fibrillary acidic protein
(GFAP) (A.×100, B.×100).
Ki-67 (MIB-1) proliferation-related labeling index were
studied for immunohistochemical procedures. Micros-
copically, the tumor disclosed dura-attached solid tumor,
which is composed of haphazardly arranged oval to spindle
cells with numerous variable sized vascular structure. The
tumor showed highly cellular spindle cell tumors in a
collagen-rich background, and exhibited regional variation.
Tumor cells had enlongated nuclei with a delicate chromatin
pattern, and scant eosinophilic cytoplasm. Few mitotic figures
were also noted. But there was no intranuclear inclusions,
cellular whorls, or psammoma bodies (Fig. 3).
Immunohistochemically, the tumor was strongly, and wi-
dely, positive for CD34 and vimentin. There was no staining
for EMA, S-100 protein, cytokeratin, and GFAP (Fig. 4). On
the basis of these findings, the final diagnosis of these tumor
was solitary fibrous tumor.
The patient made a rapid postoperative recovery. The
preoperative symptom resolved completely. One year after
surgery, neurological status remains stable, with no radiographic
evidence of disease progression on MRI scans (Fig. 5).
Discussion
I ntracerebral solitary fibrous tumor is a newly described
clinical entity. The rarity of benign intracerebral SFT has
currently been related to paucity of true connective elements
within the central nervous system7). Their histogenesis is still
unknown. The main differnetial diagnosis of intracranial SFT
includes fibrous meningioma and hemangiopericytoma.
Fibrous meningiomas can be identified by the immuno-
histochemical pattern, but preoperative differential diagnosis
based on neuroimaging is difficult3,11). T2-weighted MR
VOLUME 37 March, 2005 233
Meningeal Solitary Fibrous Tumor
Fig. 5. Postoperative magnetic resonance images show total
removal of the parasagittal mass and no radiographic evidence of
recurrence.
imaging is useful for excluding hemangiopericytomas.
Hemangiopericytomas do not contain the areas of thick
bands of collagen which appear as hypointense on the T2-
weighted images3,11). Strong immunoreactivity for CD34, as
in this cases, is helpful for making the diagnosis3,4,11,12), but
such findings are not specific for SFT11).
On MRI, SFT are well defined, enhancing, homogeneous,
or slightly heterogeneous, lesions with intermediate T1-, and
low T2, signal. It has been suggested that relatively hypo- and
hyperintense areas on T2-weighted images corespond,
respectively, to collagenous and hypercellular regions of
tumor9). Thickened dural tail, hyperostosis, skull erosion, and
capping cysts may all be seen3,10,12,13). In general, radiological
appearences of SFT are non-specific and would suggest the
diagnosis of meningioma.
Despite some morphological similarities to other spindle-
cell tumors such as fibrous meningioma, schwannoma, and
meningeal fibrosarcoma or myofibroblastoma, the immun-
ohistochemical pattern of SFT is distinctive3,11). SFT are
strongly positive for CD34 and vimentin, with no staining in
the tumor itself for the neural crest markers, S-100 protein,
GFAP, EMA, cytokeratin or vascular antigens4,11). The histo-
pathologic features of SFT may mimic fibrous meningiomas,
but the fibrous meningiomas can be excluded by the presence
of storiform pattern, calcification of collagen and psammoma
234 J Korean Neurosurg Soc 37
bodies, and frequent positive staining for EMA and S-100
protein12). It should be noted, however, that CD34 is not
specific for SFT as weak, usually patchy, staining may be
seen in meningiomas, neurofibromas, and hemangioperi-
cytomas4,11). As with all tumors, however, the overall hist-
ological appearances and immunohistochemical pattern must
be considered together.
Conclusion
W e have reported a case of meningeal SFT. SFT should
be included in the differential diagnosis for extra-
axial brain lesions. Experience with SFT would suggest that
whatever the extent of surgical resection, and regardless of
their histological appearance, meningeal SFT should be
followed with great care in the long-term.
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